If your son’s testis has not settled in the scrotum, timely assessment matters. Dr. Pritesh Maheshwari, paediatric surgeon in East Delhi, examines children with undescended testis and explains whether orchidopexy is needed, and when.
If your child has sudden pain or swelling in the testis or scrotum, redness, nausea or vomiting, go to the nearest hospital emergency department now. Do not wait for a clinic appointment, even if the testis is already known to be undescended.
An undescended testis, also called cryptorchidism, means one or both testes have not reached their normal place in the scrotum. Many testes come down by themselves in the first few months of life, but descent after about six months of age is unlikely. That is why international guidelines advise seeing a paediatric surgeon by six months, corrected for prematurity.
If neither testis can be felt in a newborn, especially with any other difference in the genitals, ask for specialist assessment promptly rather than waiting for the six-month mark.
Dr. Maheshwari asks about the birth, any prematurity, and whether the testis has ever been seen in the scrotum. He then examines your child while relaxed and warm, because cold and anxiety can pull a normal testis upwards. The examination answers three questions:
A palpable testis usually lies in the groin. A non-palpable testis may be high in the groin, inside the abdomen, or absent.
Bilateral cases need closer evaluation.
A retractile testis moves up with a muscle reflex but can be brought down into the scrotum. It usually does not need surgery but should be checked at least once a year, because a small number move up for good. This later rise is called an ascending testis and is treated like an undescended one.
Ultrasound is not usually needed. International guidelines advise against routine ultrasound or other scans before seeing a surgeon, because they rarely change the plan. Tests are ordered only when the examination calls for them, for example when neither testis can be felt.
You leave with a clear plan: review at a set date, or surgery with a recommended timing.
Most international guidelines recommend orchidopexy between six and 18 months of age, and several prefer surgery around the first birthday. Operating in this window gives the testis the best chance of normal development.
A child diagnosed later, including an older boy with an ascending testis, should still be assessed promptly. A later diagnosis is a reason to act, not a reason to wait.
Hormone injections are not recommended to bring the testis down, because they rarely work and the effect does not last.
Orchidopexy (also spelt orchiopexy) brings the testis down into the scrotum and fixes it there. It is done under general anaesthesia, so your child is asleep throughout.
Used for most testes that can be felt. Through a small cut in the groin, the scrotum, or both, the surgeon frees the testis and its cord and secures it in a pouch under the scrotal skin. Stitches are usually dissolvable.
Used when the testis cannot be felt, which is about one case in five. A small camera passed through the navel shows whether the testis is inside the abdomen. If it is, it can often be brought down in the same operation; a testis lying very high may need two stages a few months apart to protect its blood supply.
Laparoscopy is not better for every child: the route depends on where the testis is.
Before surgery your child has a pre-anaesthesia check, and the hospital gives fasting instructions. Recovery is usually quick.
Every operation carries some risk. Reduced blood supply is more likely when the testis starts inside the abdomen. After surgery, a follow-up visit checks the position and growth of the testis. Dr. Maheshwari will discuss the risks that apply to your child.
Bringing the testis down makes it easy to examine and may protect its future function, but it cannot guarantee fertility. Men with a history of undescended testis, especially on both sides, have a higher chance of reduced fertility, and a higher risk of testicular cancer than other men even after surgery. Treatment before puberty lowers that risk. After puberty, your son should learn to check his testes regularly.
Dr. Pritesh Maheshwari is a paediatric surgeon with an MCh in Paediatric Surgery from AIIMS New Delhi. He consults at Maheshwari Multispeciality Clinic for families across East Delhi and nearby NCR, as part of his paediatric urology consultation service.
A fair estimate needs an examination first.
After the consultation, ask for a written estimate that lists what is included and excluded.
If your son has been diagnosed with an undescended testis, or you are not sure whether his testis is in the right place, book an assessment at our Delhi clinic.
If your son has been diagnosed with an undescended testis, or you are not sure whether his testis is in the right place, book an assessment at our Delhi clinic. For sudden pain or swelling, go to the nearest emergency department instead.
